An endoscope of that kind is known from DE 100 45 036 C1. The known endoscope has a multi-lumen probe as well as a handle provided at the proximal end of the probe. An optical system extends in at least one of the probe lumens. There is also a working lumen for a surgical instrument. A control element for example in the form of a pulling wire or a pulling cable is connected to the distal end of the probe and is guided movably on the probe in the axial direction thereof. In that way a distal portion of the probe of a given length can be bent round and also rotated. That affords a therapeutic endoscope which can be easily used in surgical interventions.
U.S. Pat. No. 4,762,120 discloses an endoscope having a handle and a catheter arrangement in which the catheter arrangement is fixed rotatably and releasably to the handle. In the assembled condition the fibre optics provided in the catheter probe is aligned with the ocular optical means provided in the handle. For that purpose an optical means exit provided at the catheter arrangement is releasably connected to the handle. The catheter probe has further lumens whose exits at the proximal end are outside the handle. A control element for guiding the probe to the target location is not provided in that endoscope.
In the case of endoscopes with multi-lumen probes, maintenance and in particular decontamination are extremely difficult. That gives rise to high servicing costs and there are long interruption times between the respective uses in order to achieve reliable decontamination.
Therefore the object of the invention is to provide an endoscope having a controllable and flexible multi-lumen probe, in which simple maintenance is achieved and in particular difficulties which occur in decontamination are eliminated.
The invention provides that the proximal end portion of the optical system which projects beyond the proximal end of the catheter probe is guided in a flexible tube. The optical system which in particular is in the form of fibre optics preferably includes the observation optical system and the illumination optical system. The flexible tube is of an elastic nature in its longitudinal direction and can comprise for example silicone rubber. The tube is fixedly connected to the optical system at a fixing location which is removed from the proximal end of the catheter probe. Preferably the fixing location at which the tube is fixed to the optical system is disposed at the proximal end of the optical system. The elasticity of the tube provides that a prestressing is applied to the optical system in the longitudinal direction thereof so that the distal end of the optical system is pressed against a translucent cover provided at the distal end of the optical system lumen in the catheter probe as a closure element. In that arrangement the resiliently elastic tube is stressed between its distal tube end which is fixed releasably in the region of the proximal end of the probe and the fixing location to the optical system.
Advantageous developments of the invention are recited in the appendant claims.
The translucent sealing means or cover, for example in the form of a glass or plastic plate or disc, is fitted sealingly into the lumen material. The optical system lumen is hermetically closed off in relation to the target location, at the distal end. The translucent cover can also have optical properties, in particular imaging properties, and can be for example in the form of a lens. The translucent cover in the form of a plate or lens can be fitted in hermetically sealing relationship into the distal opening of the optical system lumen for example by adhesive, welding into the probe material which in particular comprises plastic material, or in the operation of shaping the probe by extrusion, injection moulding or the like. The optical system, in particular the illumination and observation optical system, is arranged displaceably in the optical system lumen and in the tube and is removable from the optical system lumen and the tube.
A connecting portion can be provided at the proximal end of the optical system, and an illumination device and/or an ocular can be connected to the connecting portion. The connecting portion has suitable adaptor devices for the connection of the illumination device and the ocular. As the illumination device it is also possible for an emergency illumination means which is possibly battery-operated to be connected to the connecting portion and thus to the illumination optical fibres of the optical system. The ocular is connected to the viewing fibre bundle of the optical system by way of the connecting portion.
The fixing location at which the proximal end of the tube is connected to the optical system can be provided at the connecting portion and is preferably in the form of a Luer lock connection. The optical system can be removed from the optical system lumen of the catheter probe and from the tube by virtue of the releasability of the connection of the optical system and the tube. Besides the prestressing effect on the optical system the tube also affords protection for the optical system between the proximal end of the catheter probe and the connecting portion.
By virtue of its elasticity the tube forms a length-compensating device which acts with a given prestressing force like a spring on the light guide/fibre bundle of the optical system. The distal end of the optical system is pressed against the translucent cover at the distal end of the optical system lumen and, when the distal portion of the probe is bent, the change in length is compensated by the resilient prestressing force. The optical system remains in contact against the cover with a certain pressing force. When the distal end of the probe moves back into the initial position of being aligned with the remaining portion of the probe, the optical system bundle is moved back into the initial position again by displacement in the optical system lumen in opposition to the resilient prestressing force.
Preferably the catheter probe is mounted rotatably to the handle. For that purpose the proximal end of the catheter probe can be supported in a rotary bearing on the handle. The rotary bearing preferably has a longitudinal bore which aligns with a control lumen of the catheter probe, in which the control element is arranged. The control element can thus be passed through the rotary bearing to a slider in or at the handle. The control element is fixedly connected to the slider. The control element can be displaced in the axial direction by the slider for bending the distal portion of the probe. The bent end of the probe can be additionally controlled by rotation of the catheter probe with respect to the handle. The rotary bearing permits a 360° rotation of the catheter probe with respect to the handle.
Fixing of the catheter probe to the rotary bearing is effected by means of a releasable fixing device, in particular a Luer lock connection. Fixing of the control element to the slider is also effected by means of a releasable fixing device, for example by means of a clamping screw.
Preferably the catheter probe is releasably connected to the rotary bearing on the handle only in the region of the guide wire lumen. The proximal exits for the other probe lumens are not connected to the handle. Those probe lumen exits can be connected to associated terminal devices independently of the handle and outside the handle. The optical system which is guided through the tube is connected outside the handle to the illumination system, for example an emergency illumination device, and to the ocular which can preferably be fixed to the handle, as already described hereinbefore. The observation optical system can also be connected in known manner by way of the ocular to a camera/monitor system or a suitable observation device.
In addition a flushing outlet at the proximal end of a flushing lumen of the probe can be connected to a flushing/suction removal system. In addition a working lumen or a plurality of working lumens for a surgical instrument or for a plurality of surgical instruments can be connected to actuating elements with which the respective surgical element is actuated. For that purpose the respective surgical element is guided removably in the associated working lumen.
The multi-lumen probe is preferably in the form of a disposable component. For that purpose the probe can be produced by injection moulding or extrusion or by another suitable shaping procedure and can comprise plastic material. Moreover an attachment portion of a strong material, for example plastic material, at which the lumen exits for the plurality of probe lumens and the guide exit which can be connected to the rotary bearing on the handle for the control element can be provided at the proximal end of the probe. The lumen exits and the guide exit can preferably have connecting elements for Luer locks, bayonet fixings or the like or can be in the form of coupling portions of such fixings and can also comprise the strong material of the proximal attachment portion. Preferably the proximal attachment portion can also be in the form of an injection moulding or extrusion which together with the flexible probe forms a disposable component.
Decontamination of the surgical instrument which can be removed from the working lumen can be effected in a simple fashion. The optical system which is removed from the optical system lumen is not contaminated during the surgical intervention as the distal end of the optical system volume is protected in relation to the target location by the translucent sealing means at the distal end and the surrounding probe material protects the optical system in terms of its lengthwise extent. As the catheter probe is preferably in the form of a disposable component a new probe which has not yet been used is connected to the handle, as described above, for a fresh use, in which case the optical system can be re-usably fitted into the optical system lumen.
Preferably the catheter probe can have a balloon to which a dilation medium, for example a gas or a liquid, for balloon expansion, can be fed by way of a balloon lumen in the catheter probe.
Furthermore the catheter probe can have a guide wire lumen through which a guide wire can be passed from the distal end of the probe to an exit opening disposed behind the balloon, in the catheter wall. Then, by means of the guide wire, the catheter probe can be guided to a target location in the body of the patient in particular with the portion of the probe which has the balloon or with the portion of the probe which can be flexurally deflected.
The control element is guided in a flexible support tube in the catheter probe. The support tube terminates at a spacing in front of the distal end of the catheter probe. That means that the flexibility and bendability of the portion of the probe which is to be bent is not adversely affected by the support tube. The spacing relative to the distal end corresponds approximately to the length of the distal portion of the probe, which is to be bent over by the control element.
Advantageously different catheter probes can be used with the handle, the optical system and the ocular, for different purposes of use in diagnostics and therapy. The handle, the optical system and the ocular form re-usable modular components which can be assembled to catheters of differing lengths, outside diameters and with differing numbers of lumens and with differing dimensions in respect of the diameters of the lumens, in particular working lumens, to form an endoscope which can be used in many different ways (multitasking endoscope). For example a widely varying range of instruments can also be directly incorporated in the working passage, being in particular mounted therein, so that an endoscope catheter with instrument forms a disposable system which does not give rise to any decontamination problems. The modular optical system which can be introduced affords a controllable and rotatable endoscopic instrument (visio instrument). In addition a balloon catheter can be embodied in the form of a disposable component with re-usable non-contamination optical system which can be removed from the balloon catheter.